Federal Register / Vol. 70, No.
15 / Tuesday, January 25, 2005 / Notices
regulations/pra/, or E-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 768–1326.
Written comments and
recommendations for the proposed
information collection must be mailed
within 30 days of this notice directly to
the OMB desk officer: OMB Human
Resources and Housing Branch,
Attention: Christopher Martin, New
Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: January 13, 2005.
Dawn Willingham,
Acting, CMS Paperwork Reduction Act
Reports Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1319 Filed 1–24–05; 8:45 am]
BILLING CODE 4120–03–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–8003, CMS–
10060, CMS–287, CMS–R–245, CMS–21/
CMS–21B, CMS–64, and CMS–R–209]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS) is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Home and
Community-Based Waiver Requests and
Supporting Regulations in 42 CFR
VerDate jul<14>2003 13:14 Jan 24, 2005 Jkt 205001
3531
440.180 and 441.300–.310; Use: Under a
Secretarial waiver, States may offer a
wide array of home and community-
based services to individuals who
would otherwise require
institutionalization. States requesting a
waiver must provide certain assurances,
documentation and cost & utilization
estimates which are reviewed, approved
and maintained for the purpose of
identifying/verifying States’ compliance
with such statutory and regulatory
requirements; Form Number: CMS–8003
(OMB#: 0938–0449); Frequency: Other:
When a State requests a waiver or
amendment to a waiver; Affected Public:
State, Local or Tribal Government;
Number of Respondents: 50; Total
Annual Responses: 132; Total Annual
Hours: 7,930.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Quality
Assessment and Performance
Improvement (QAPI) Project
Completion Report and Supporting
Regulations in 42 CFR 422.152; Use:
This project completion report derives
from the Quality Improvement System
for Managed Care (QISMC) Standards
and Guidelines as required by the
Balanced Budget Act of 1997 (as
amended by Balanced Budget
Refinement Act of 1999) and the related
regulations, 42 CFR 422.152. These
regulations established QISMC as a
requirement for Medicare+Choice (M+C)
Organizations by requiring improved
health outcomes for enrolled
beneficiaries. The provisions of QISMC
specify that M+C organizations will
implement and evaluate quality
improvement projects. The form
submitted herein will permit M+C
organizations to report their completed
projects to CMS in a standardized
fashion for evaluation by CMS of the
M+C Organization’s compliance with
regulatory provisions. This form will
improve consistency and reliability in
the CMS evaluation process, as well as
provide a standardized structure for
public use and review; Form Number:
CMS–10060 (OMB#: 0938–0873);
Frequency: Annually; Affected Public:
Business or other for-profit and Not-for-
profit institutions; Number of
Respondents: 155; Total Annual
Responses: 155; Total Annual Hours:
620.
3. Type of Information Request:
Revision of a currently approved
collection; Title of Information
Collection: Home Office Cost Statement
and Supporting Regulations in 42 CFR
413.17 and 413.20; Use: Home Office
Cost Statement, is filed annually by
Chain Home Offices to report the
PO 00000 Frm 00025 Fmt 4703 Sfmt 4703 E:\FR\FM\25JAN1.SGM
information necessary for the
determination of Medicare
reimbursement to components of chain
organizations. Many providers of service
participating in Medicare are
reimbursed, at least partially, on the
basis of the lesser of reasonable cost or
customary services for services
furnished to eligible beneficiaries. When
providers obtain services, supplies or
facilities from an organization related to
the provider by common ownership or
control, 42 CFR 413.17 requires that the
provider include in its costs, the costs
incurred by the related organization in
furnishing such services, supplies or
facilities. Revisions to this form include
the addition of columns for more
detailed reporting and the elimination
of other columns that were deemed
unnecessary; Form Number: CMB–287
(OMB# 0938–0202); Frequency:
Annually; Affected Public: Not-for-profit
institutions and Business or other for-
profit; Number of Respondents: 1,231;
Total Annual Responses: 1,231; Total
Annual Hours: 573,646.
4. Type of Information Request:
Extension of a currently approved
collection; Title of Information
Collection: Medicare and Medicaid
Programs; OASIS Collection
Requirements as Part of the COPs for
HHAs and Supporting Regulations in 42
CFR, Sections 484.55, 484.205, 484.245,
and 484.250; Use: This collection
requires HHAs to use a standard core
assessment data set, the OASIS, to
collect information and to evaluate
adult non-maternity patients. In
addition, data from the OASIS will be
used for purposes of case-mix adjusting
patients under home health PPS, and
will facilitate the production of
necessary case-mix information at
relevant time intervals in the patient’s
home health stay. Modifications were
previously made to the OASIS forms to
allow for the preservation of masking of
personally identifiable information for
the non-Medicare/non-Medicaid
individuals; Form Number: CMS–R–245
(OMB# 0938–0760); Frequency: Other:
Upon patient assessment; Affected
Public: Business or other for-profit, Not-
for-profit institutions, Federal
Government, and State, Local or Tribal
Gov.; Number of Respondents: 7,582;
Total Annual Responses: 10,156,569;
Total Annual Hours: 8,556,995.
5. Type of Information Request:
Extension of a currently approved
collection; Title of Information
Collection: Quarterly Children’s Health
Insurance Program (CHIP) Statement of
Expenditures for Title XXI; Use: States
use forms CMS–21 and CMS–21B to
report budget, expenditure, and related
statistical information required for
25JAN1
 3532 Federal Register / Vol. 70, No. 15 / Tuesday, January 25, 2005 / Notices
implementation of the Children’s Health
Insurance Program. The information
provided by these forms is used by CMS
to prepare the grant awards to States for
the Medicaid and CHIP programs, to
ensure that the appropriate level of
Federal payments for State expenditures
under the Medicaid program and CHIP
are made in accordance with the CHIP
related Balanced Budget Act legislation
provisions, and to track, monitor, and
evaluate the numbers of related children
being served by the Medicaid and CHIP
programs; Form Number: CMS–21 and
CMS–21B (OMB# 0938–0731);
Frequency: Quarterly; Affected Public:
State, Local or Tribal Gov.; Number of
Respondents: 56; Total Annual
Responses: 448; Total Annual Hours:
7,840.
6. Type of Information Request:
Revision of a currently approved
collection; Title of Information
Collection: Quarterly Medicaid
Statement of Expenditures for the
Medical Assistance Program; Use: The
State Medicaid agencies use the form
CMS–64 for the Medical Assistance
Program to report their actual program
benefit costs and administrative
expenses to CMS. CMS uses this
information to compute the Federal
financial participation for the State’s
Medicaid Program costs. The structure
of the current from CMS–64 has evolved
from the previous forms used for
reporting and has been revised.
Classification, identification, and
referencing used in the CMS–64 forms
has been in place for several years, is
readily understood and accepted by the
report users, and is supported by strong
sentiments in both CMS and the States
to maintain the existing format.
Therefore, our modifications have been
made to maintain the current reporting
format by incorporating all changes into
the existing report structure; Form
Number: CMS–64 (OMB# 0938–0067);
Frequency: Quarterly; Affected Public:
State, Local or Tribal Gov.; Number of
Respondents: 56; Total Annual
Responses: 224; Total Annual Hours:
16,464.
7. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare and
Medicaid Programs; Use and Reporting
OASIS Data as Part of the CoPs for
HHAs and Supporting Regulations in 42
CFR 484.11 and 484.20; Form No.:
CMS–R–209 (OMB# 0938–0761); Use:
HHAs are required to report data from
the OASIS as a condition of
participation. Specifically, the above
named regulation sections provide
guidelines for HHAs for the electronic
transmission of the OASIS data as well
VerDate jul<14>2003 13:14 Jan 24, 2005 Jkt 205001
as responsibilities of the State agency or
OASIS contractor in collecting and
transmitting this information to CMS.
These requirements are necessary to
achieve broad-based, measurable
improvement, in the quality of care
furnished through Federal programs,
and to establish a prospective payment
system for HHAs; Frequency: Monthly;
Affected Public: Business or other-for-
profit, Federal Government, State, Local
or Tribal Government, Not-for-profit
institutions; Number of Respondents:
7,582; Total Annual Responses: 93,621;
Total Annual Hours: 921,271.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web site
address at http://www.cms.hhs.gov/
regulations/pra/, or E-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 786–1326.
Written comments and
recommendations for the proposed
information collections must be mailed
within 60 days of this notice directly to
the CMS Paperwork Reduction Act
Reports Clearance Officer designated at
the address below: CMS, Office of
Strategic Operations and Regulatory
Affairs, Division of Regulations
Development, Attention: Melissa
Musotto, Room C5–14–03, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: January 13, 2005.
Dawn Willinghan,
Acting, CMS Paperwork Reduction Act
Reports Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1320 Filed 1–24–05; 8:45 am]
BILLING CODE 4120–03–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Proposed Projects
Title: Employment Retention and
Advancement (ERA) Evaluation 42-
Month Survey.
OMB No.: New Collection.
Description: The Employment
Retention and Advancement (ERA)
Evaluation is sponsored by the
Administration for Children and
Families (ACF) of the U.S. Department
PO 00000 Frm 00026 Fmt 4703 Sfmt 4703 E:\FR\FM\25JAN1.SGM
of Health and Human Services (HHS),1
and involves the conduct of a multi-year
evaluation that studies the net impact
and cost-benefits of programs designed
to help Temporary Assistance for Needy
Families (TANF) recipients, former
TANF recipients or families at risk of
needing TANF benefits retain and
advance in employment.2 The ERA
Evaluation involves 15 random
assignment experiments in eight states,
testing a diverse set of strategies
designed to promote stable employment
and/or career advancement for low-
income people. The ERA Evaluation
will generate rigorous data on the
implementation, effects and costs of
these alternative approaches. The data
collected as part of the 42-month survey
will be used for the following purposes:
• To study ERA’s long-term impacts
on employment, earnings, participation,
educational attainment and income;
• To gather data on a wider range of
outcome measures than is available
through welfare or Unemployment
Insurance records in order to
understand how individuals were
affected by ERA; participation in
employment and education activities;
educational attainment; employment
history; marriage, household
composition and child care; housing;
household income; household food
insecurity; health coverage and status;
and child outcomes;
• To build upon data collected as part
of the earlier 12-month survey wave;
• To conduct non-experimental
analyses, in addition to experimental
analyses, and provide a descriptive
picture of the circumstances of low-
wage workers; and
• To obtain participation information
important to the evaluation’s cost-
benefits component.
Respondents: The respondents of the
42-month survey are Temporary
Assistance for Needy Families (TANF)
applicants, current and former TANF
recipients or individuals in families at
risk of needing TANF benefits (working
poor and hard-to-employ) who are in
the research sample in a subset of the 15
programs participating in the ERA
Evaluation. Survey participants will be
administered a telephone survey
approximately 42 months after the date
they were enrolled in the research
sample and randomly assigned to the
treatment or control group. For those
individuals who cannot be reached by
phone, survey firm staff will attempt to
contact them in person. A total of
1 The U.S. Department of Labor has also provided
funding to support the ERA project.
2 From the Department of Health and Human
Services RFP No.: 105–99–8100.
25JAN1